Another Nail in the Coffin for Diet Soda

All right, Dr. Peters, will you lay off the diet-soda-bashing melodrama?

No.  The answer is no.

You've read my articles before about how diet soda actually promotes weight gain rather than weight loss, and more seriously, raises the risk of stroke significantly.  Is that Diet Coke fix worth a brain attack that could lead to permanent neurologic deficit, or even death?

Now French researchers have published findings (1) that consumption of lots of diet soda more than doubles the risk of developing type 2 diabetes, compared to non-soda drinkers.  This is an even higher risk than regular soda drinkers!  As you know, type 2 diabetes is like aging on fast forward, accelerating the development of cardiovascular disease, nerve problems, kidney disease, eye problems, and other complications.  But wait -- how much is "a lot" of diet soda?  More than about 600 ml per week.  Or for us Americans, about 20 fluid ounces.  Yes, just one 20 oz. bottle per week.  Know anyone who drinks more pop than that?

So let's look at the arguments of the beverage industry:

• "Diet soda is a good choice for those trying to lose weight, since it contains zero calories."  FALSE
• "Diet soda is a good choice for diabetics, since it contains no sugar."  FALSE

Consider the alternatives:

• Get a reusable water bottle, and make pure water your go-to drink.  Add a squirt of real lemon or lime juice for a little flavor, if you miss it.  No need to replace one highly processed food (diet soda) with another ("designer" waters).
• Green tea:  go beyond the Lipton -- there are many different varieties, with flavors that should appeal to everyone.  And how about a 20-30% lower risk of cardiovascular disease as a bonus?

1.  Consumption of artificially and sugar-sweetened beverages and incident type 2 diabetes in the Etude Epidémiologique auprès des femmes de la Mutuelle Générale de l'Education Nationale–European Prospective Investigation into Cancer and Nutrition cohort.  January 30, 2013, doi: 10.3945/​ajcn.112.050997.  Am J Clin Nutr March 2013 ajcn.050997

What's Wrong with a Little Snack?

...Nothing, as long as it does not turn into a big snack.

One of the major factors that has been consistently found to influence weight gain or loss is controlling portion size.  Sometimes this is easier said than done -- for example, at buffets where the available portions are seemingly endless.

Researchers at Cornell University (1) recently ran an experiment to test this in a new way.  They gave two groups of people different serving sizes of snack foods (chocolate, pie, and potato chips) -- either small or large portions.  Of course, the choice of foods was not ideal (unless you count the health benefits recently coming to light for chocolate), but the point of the study was to look at calorie intake.  Not surprisingly, the small serving group took in fewer calories -- an average of 100 fewer.  What was important, though, is that they found no difference in reported satisfaction between the two groups.

This highlights a major principle of our food consumption:  the difference between hunger and appetite.  Hunger is the physiological need for food, detected and driven by the hypothalamus in the brain.  Appetite is the psychological desire for food, which can be the result of numerous factors -- one of which might be how much we have available in front of us.

So if you're going to have a snack, remember these principles:

• Measure out a small serving of snack ahead of time.  Don't grab the whole bag.
• Eat slowly -- give your brain a chance to catch on to that feeling of a satisfied appetite before reaching for more.

1.  Van Kleef, Ellen, Mitsuru Shimizu and Brian Wansink (2013). Just a bite: Considerably smaller snack portions satisfy delayed hunger and craving, Food Quality and Preference, 27(1):96-100

Exercise for Weight Loss: Take a Hint from Goldilocks

This is the time of year when many folks' New Year's resolutions include shedding a few (or a lot) of those excess pounds.  A healthy, balanced diet with proper portion control is the place to start, of course.  And starting an exercise program has tremendous health benefits, even beyond the waistline.  New research suggests, though, that more is not necessarily better -- even with something as healthy as physical activity.

Researchers at the University of Copenhagen in Denmark (1) explored the question of the effect of amount of exercise on weight loss.  They looked at overweight sedentary men, dividing them into three groups:

• a control group (no exercise)
• moderate exercise (300 calories burned per day, or about 30 minutes of running or cycling)
• high exercise (600 calories burned, or about 60 minutes per day)

After 13 weeks, they examined weight loss in the three groups.  Not surprisingly, the control group showed no change in weight.  The high-exercise group lost an average of about five pounds -- respectable, but actually less than expected, given the number of calories these gentlemen were burning.  But the moderate exercisers actually lost more weight:  about seven pounds on average, or forty percent more than the high-exercise group!  What could account for this Goldilocks effect -- not too much, not too little, but just right?

There is one major factor that the researchers did not examine:  body composition.  In other words, how much muscle and fat did each subject have at the beginning and end of the study?  The high exercisers were probably gaining more muscle than the moderate group, resulting in a lower net weight loss.  For this reason, I like to measure body composition (via bioimpedance analysis) at my clinic to more accurately track changes over time.  Lead scientist Mads Rosenkilde admits that if the study extended beyond 13 weeks, the metabolic benefit of increased muscle mass might become more noticeable in the high exercisers.

Nevertheless, there are at least two major pitfalls that the researchers identified for the high-exercise group.  The increase in calories burned seemed to lead to a compensatory increase in food intake -- this was most likely unconscious, a result of altered hormonal control over hunger signals (the set point theory).  A unique aspect of this study is that the subjects were equipped with motion sensors, to record their physical activity outside of the formal exercise periods.  The high exercisers were actually more sedentary the rest of the day compared to the moderate group -- perhaps due to fatigue, or perhaps they just felt they "deserved" more rest.

This study gives us plenty of food for thought on physical activity.  But like everything, let's take it in the context of all research, not just the latest headline:

• Any exercise is better than none at all.
• If you are using a lower intensity exercise such as walking, it might take 45-60 minutes to hit that 300 calorie burn goal.
• Short bursts of high-intensity exercise have been shown to have greater metabolic benefit overall than prolonged sessions of more moderate intensity exercise:  The improvement in insulin sensitivity can lead to better weight management with as little as 60 minutes per week. (2)

1.  Body fat loss and compensatory mechanisms in response to different doses of aerobic exercise--a randomized controlled trial in overweight sedentary males.  Am J Physiol Regul Integr Comp Physiol. 2012 Sep 15;303(6):R571-9. doi: 10.1152/ajpregu.00141.2012. Epub 2012 Aug 1.

2.  Just HIT it! A time-efficient exercise strategy to improve muscle insulin sensitivity.  J Physiol. 2010 September 15; 588(Pt 18): 3341–3342.

Seeds of Heart Health for the New Year

You've probably heard my mantra for a healthy diet (borrowed from author Michael Pollan):  "Eat food.  Not too much.  Mostly plants."  To expand on this, we can look to the Mediterranean diet -- that style of eating that is based on whole grains, vegetables, nuts, legumes (beans), and smaller amounts of animal-based protein.  This simple approach works well for maintaining a healthy body weight, and preventing chronic diseases such as cardiovascular disease.

A review (1) in the journal Clinical Lipidology (yes, you read that right; "lipidology" means the study of cholesterol and other fats) looks at dietary factors most associated with lowering cholesterol.

"The foods with the most evidence for cholesterol reduction are nuts, legumes, whole cereals rich in soluble fiber, and cocoa and its main commercial product, chocolate."

OK -- this sounds a lot like the Mediterranean diet.  What the author goes on to point out, though, is that all of these foods are actually seeds.  Obvious once someone points it out, isn't it?  Yet with as many years as I've taught patients and students about nutrition, this struck me as a beautifully concise revelation.  Even whole grains like oats are seeds.  And chocolate?  Yes, please!

Seeds contain fiber, healthy fats, and disease-busting phytonutrients.  Think of them as plant foods bursting with concentrated potential.

1.  Ros E.  How Important Is Dietary Management in Hypercholesterolemia?  Clin Lipidology. 2012;7(5):489-492.

Are You at Risk for Pneumonia with this Medication?

One of the foundations of health is a good night's sleep.  Lack of sleep can lead to consequences including obesity, aggravation of pain conditions like fibromyalgia, poor memory, and even increased risk of cardiovascular disease.  With all the benefits of getting a good night's sleep, it might be tempting to do whatever it takes to correct sleep problems -- including taking pharmaceutical sleep aids.  But let's step back and consider the consequences first.

A common class of medications prescribed for sleep (and anxiety) is the benzodiazepines ("benzos") -- with trade names like Xanax and Valium, or generic names alprazolam, diazepam, and others.  The main problem with these drugs is well known:  they're addictive, and can lead to physiological dependence.

A new study published this month (1) found an unexpected danger with benzos:  a 54% increased risk of pneumonia.  Pneumonia is one of the more serious complications of seasonal influenza, which I wrote about last week.  If you're currently taking benzos for sleep, or considering them, think about all the natural ways you can improve sleep instead.  Of course, discuss changing your medication with the prescribing physician, since it's best to wean down carefully on this type of drug.  Now if you're thinking, "I've tried all that natural stuff before!  It didn't work," my response is... really?  Everything?  Review the list below, and give these suggestions an honest try for a period of several weeks.


IMPROVING THE QUALITY OF YOUR SLEEP

1. Maintain consistent sleep and wake times. Do not push yourself to stay up past the initial signs of sleepiness. This can create epinephrine production, causing more difficulty getting to sleep later. It is good to have a “getting ready for bed” routine to relax and prepare your body for sleep. Avoid taking naps if you have trouble sleeping at night.

2. Reserve the bed for sleep and sex only. Do not read, watch TV, eat, or worry in bed. Solve daily dilemmas outside of the bedroom. If you find that you’ve been lying awake in bed for 15-20 minutes, get out of bed.  Do something mundane until you feel sleepy, and then go back to bed. Repeat this as often as needed.

3. Your sleeping environment should be quiet, cool (70 degrees or less), and comfortable. The room should be clutter-free. Reduce the amount of ambient light as much as possible. Electronic devices such as clocks, stereos, TVs and computers generate electromagnetic fields that can disturb sleep for some people. Experiment with moving these into another room or using EMF shields. Feng Shui, the Chinese art of placement, can be valuable in creating an optimal sleeping environment.

4. Exercise regularly. Exercising during the day or early evening decreases the time it takes to get to sleep and increases the amount of deep sleep obtained. Most people do better avoiding exercise late in the evening.

5. Exposure to sunlight early in the morning and late in the afternoon or evening encourages a strong circadian rhythm. The hormone melatonin, which helps create a sleep state in the body, is suppressed in light and secreted in darkness.

6. As much as possible, ensure complete darkness at night.  Darkness encourages your body’s natural production of melatonin.  Do not fall asleep with the TV or lights on.  Turn off all screens (TV, computer, video games, etc.) 30-60 minutes before bedtime.  If you wake at night to go to the bathroom, do not turn the light on.  Even this brief exposure to light at night may suppress your melatonin significantly, drastically reducing the quality of your sleep.

7. If you have problems with waking during the early hours of the morning, have a small protein snack just before bed to ensure consistent blood sugar levels throughout the night. Consistently get exposure to sunlight as late in the day as possible.

8. Improving overall health will improve the quality of your sleep. Work towards improving or eliminating health problems. Treatment modalities such as Neurostructural Integration Technique will help to relax the body. Effective stress management is essential.


THINGS THAT RELAX THE BODY AND PREPARE IT FOR SLEEP

• Warm baths, possibly adding Epsom salts or lavender oil
• Meditating for 5-30 minutes
• Breathing exercises, progressive muscle relaxation (various recordings are available) or any other means of inducing the “relaxation response”.  Daily practice brings greater results.
• Special acoustic recordings that increase specific brain wave patterns for relaxation and sleep
• Botanical treatments and aromatherapy using herbs and their essential oils (examples include chamomile, valerian, vervain (verbena), hops, lavender, passionflower, avena (oat straw), lemon balm and scutellaria (skull cap).  Consult Dr. Peters for dosages and recommendations.
• Calcium and magnesium supplementation.  Consult Dr. Peters for dosages and recommendations.
• 5-hydroxytryptophan (5-HTP) or melatonin supplementation may be necessary in individual cases.  Consult Dr. Peters for dosages and recommendations.

THINGS THAT INTERFERE WITH SLEEP

• Although alcohol may make you fall asleep, the sleep obtained after drinking is fragmented and light.
• The stimulating effects of caffeine may last up to 10 hours in some people. Avoid it in the afternoon if getting to sleep is a problem. Caffeine is present in coffee, green tea, black tea, chocolate and some medications (pain relievers, decongestants, thermogenic weight loss products, energy supplements, etc.)
• The stimulating effects of nicotine (first- or second-hand smoke) can last several hours.
• Sleeping pills, aside from being highly addictive and full of side effects, decrease the amount of time spent in deep sleep and only increase light sleep.
• B-vitamin supplements can increase energy that keeps some people awake, if taken before bed. Take B-vitamins earlier in the day.
• Do not go to bed with a very full stomach. Large quantities of protein are stimulating to the body as digestion occurs. It’s best to finish eating at least three hours before going to bed.

1.  The impact of benzodiazepines on occurrence of pneumonia and mortality from pneumonia: a nested case-control and survival analysis in a population-based cohort.  Thorax doi:10.1136/thoraxjnl-2012-202374.  

Flu Season: Here with a Vengeance

Influenza has arrived early this year, and it looks like it's gearing up to be a nasty one:  both the H1N1 and H3N2 strains of influeza A virus have been identified, as well as influenza B.  According to the Centers for Disease Control and Prevention (CDC), the rate of infection is still low this week in Illinois, but is high in southern states like Alabama and Mississippi.


Remember, this is the respiratory flu we're talking about (sore throat, fever, fatigue, muscle aches), not the "stomach flu" (more properly called gastroenteritis).  The CDC recommends flu vaccines for everyone, though there is no scientific evidence for this approach.  Furthermore, the flu vaccine might prevent flu virus infection, but does absolutely nothing to protect against related viruses that cause flu-like illnesses.  Are there good natural alternatives for preventing and treating the flu?

My first recommendation to everyone at this time of year is to get a blood test for vitamin D levels.  The proper test is called 25-hydroxyvitamin D, and the optimal level should be between 40 and 100 ng/ml.  Research has shown a clear connection between low blood levels of vitamin D and risk of catching the flu.  Flu season can span anytime from October to May – the same time period that we don’t get enough sun exposure to produce vitamin D naturally through the skin.  Coincidence?  If you have low vitamin D levels now, it’s critical to supplement at high doses under a doctor’s supervision.  Without a blood test, a supplement of 1,000-2,000 International Units per day is advisable through the winter.

Remember good hygiene – wash hands frequently, and avoid touching your eyes, nose, and mouth.  There is no need to use antibacterial soap, since this does no better than standard soap in protecting against infection.  Get a good night’s sleep to support your immune system.  For supplemental support, look into herbs such as astragalus, larch, and elderberry, as well as extra vitamin C and zinc.  If you’re exposed to people with flu or other respiratory illnesses, use a neti pot or squeeze bottle with plain salt water to rinse the nasal passages, twice a day.

Flu vaccination is important for those with asthma and other lung problems; for nursing home residents and health care workers; and for those with suppressed immune systems.  For the rest of us, take care of yourself naturally.  At the first sign of illness, use supplemental support often:  elderberry and andrographis every two hours for 24-48 hours can help to shorten the duration and severity of your misery.

Natural Medicine Myth #5: One-A-Day

This is a continuation of my series (in no particular order) on misperceptions in the field of natural medicine.  My previous articles focused on policosanol, cinnamon, systemic candida, and acai berry.

Those of you who know my articles and recommendations will find it no surprise that therapeutic lifestyle changes are the foundation of naturopathic medicine:

• diet
• exercise
• sleep
• stress management

In many cases, though, specific nutritional and herbal supplements can be critical for supporting a patient's vis medicatrix naturae:  the healing power of nature.  Particularly in the case of complex or chronic disease, such supplements are often necessary for a certain period of time.

One thing that often surprises patients is the dosages I recommend for many nutritional and herbal supplements.  I think that many of us have been conditioned by "One-A-Day" multivitamins to think that all supplements work that way.  In fact, this under-dosing is a key reason why many folks find that self-treatment with herbs and supplements is ineffective.

As an example, take one of my favorite supplements:  fish oil.  The beneficial components of fish oil are the long-chain omega-3 fatty acids, EPA and DHA (that's eicosapentaenoic acid and docosahexaenoic acid for you nutritional biochem geeks out there).  Some folks take one softgel a day of fish oil -- 1000 milligrams!  Sounds like a lot, doesn't it?  Well, research shows that for general cardiovascular health, you should take around 1000 mg of omega-3 fatty acids per day.  "Well, great, then," you think, "I guess I'm covered."  Hold it right there:  fish oil supplements are not 100% omega-3 fats; each softgel might have only 300-400 mg of omega-3s.  So now you're faced with 3-4 softgels per day to get the recommended amount.  Do you see why I recommend liquid cod liver oil so often now?  Much easier to blend a teaspoon into a breakfast smoothie, yielding 1200 mg of omega-3s.

If you already have conditions such as high triglycerides that can benefit from omega-3 supplementation, now you need to up that dose to 2000-3000 mg per day:  7-10 softgels, or 2 - 2.5 teaspoons of liquid.  Omega-3 fats can benefit so many different conditions, such as autoimmune diseases, skin problems, menstrual cramps, depression, and anxiety -- as long as you're taking the proper dose.

Feel a cold coming on?  Yes, zinc lozenges can help -- as long you get a total dose of at least 75 mg of zinc per day (be sure to take with food, to avoid stomach upset).  Herbs such as echinacea, and my favorite combo of lomatium (Lomtium dissectum) and osha (Ligusticum porteri), are wonderful immune boosters -- just be sure take a dose every 2 hours during those first couple of days of a cold.  Less than that, you might as well skip it.

Nutritional and herbal supplements require these larger doses since they work synergistically to support the body's natural functions, rather than to suppress symptoms like pharmaceuticals.  So shift your mindset, and reap the benefits that nature has to offer.